| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
3,125 |
2,941 |
$598K |
| T4533 |
Youth size brief/diaper |
2,738 |
2,594 |
$502K |
| T4528 |
Adult size pull-on xl |
1,148 |
1,098 |
$203K |
| T4526 |
Adult size pull-on med |
1,588 |
1,515 |
$202K |
| T4535 |
Disposable liner/shield/pad |
2,380 |
2,267 |
$199K |
| A4554 |
Disposable underpads |
2,251 |
2,201 |
$188K |
| T4537 |
Reusable underpad bed size |
2,928 |
2,850 |
$172K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,520 |
1,312 |
$163K |
| T4527 |
Adult size pull-on lg |
1,078 |
1,029 |
$156K |
| K0108 |
W/c component-accessory nos |
324 |
222 |
$81K |
| T4522 |
Adult size brief/diaper med |
653 |
604 |
$59K |
| E2617 |
Custom fab w/c back cushion |
13 |
12 |
$35K |
| E1161 |
Manual adult wc w tiltinspac |
12 |
12 |
$33K |
| T4541 |
Large disposable underpad |
727 |
683 |
$23K |
| E2609 |
Custom fabricate w/c cushion |
13 |
12 |
$21K |
| A9901 |
Delivery/set up/dispensing |
68 |
67 |
$9K |
| E1028 |
W/c manual swingaway |
40 |
34 |
$7K |
| E0973 |
W/ch access det adj armrest |
17 |
17 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
15 |
15 |
$3K |
| E0955 |
Cushioned headrest |
13 |
13 |
$2K |
| E2231 |
Solid seat support base |
13 |
13 |
$2K |
| E2211 |
Pneumatic propulsion tire |
27 |
27 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
15 |
15 |
$2K |
| K0040 |
Adjustable angle footplate |
14 |
14 |
$2K |
| T4523 |
Adult size brief/diaper lg |
12 |
12 |
$2K |
| E2213 |
Pneumatic prop tire insert |
26 |
26 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
30 |
30 |
$1K |
| E0961 |
Wheelchair brake extension |
13 |
13 |
$730.86 |
| T4542 |
Small disposable underpad |
27 |
24 |
$574.20 |
| E0951 |
Loop heel |
18 |
15 |
$569.40 |